Special Tests

T or F: Patrick's test is synonymous with the FABER test

TRUE

3 special tests for shoulder instability

1. anterior apprehension test 2. posterior apprehension test 3. sulcus sign (inferior instability)

What special test is associated with the sequence depicted in the image? a. Craig's test b. Ely's test c. quadrant scour d. sign of the buttock

B Ely's test requires the patient to be positioned in prone while the therapist passively flexes the patient's knee. Rectus femoris tightness will result in spontaneous hip flexion occurring simultaneously with passive knee flexion.

The anterior apprehension test for the shoulder places the joint in which position? a. extension and ER b. horizontal adduction and IR c. abduction and ER d. adduction and ER

C The anterior apprehension test places the shoulder in a position of compromise for an anterior shoulder instability/dislocation (i.e., abduction, lateral rotation).

Special test for degenerative joint disease at the hip

Quadrant Scouring Test Pt. positioned in supine. PT passively flexes and adducts the hip with knee in maximal flexion. PT then applies compressive force to femur and passively rotates pts. hip + = crepitus, grinding, and catching

Gapping Test

Pt. supine. PT crosses hands and applies downward pressure to both ASIS simultaneously + for sprain of the anterior sacroiliac ligaments with pain in the SIJ, gluteus, or posterior leg

Sacroiliac Joint Stress Test

Purpose: Sacroiliac Joint Dysfunction Method: Pt. is supine. PT crosses his/her arms, places the palms on the pt's anterior superior iliac spine. PT applies a downward & lateral force. Positive Test: Unilateral pain to the sacroiliac joint or gluteal area.

3 special tests for neurological dysfunction at the elbow

1. Elbow flexion test (cubital tunnel syndrome) 2. Pinch grip test (anterior interosseous nerve) 3. Tinel's Sign (ulnar nerve)

Cervical Distraction Test

Pt. seated, PT places one hand under chin and the other hand under occiput and applies upward distraction force. + for cervical nerve root compression if pain is decreased with distraction force

4 special tests for meniscal pathology

1. Apley's compression 2. Bounce home 3. McMurray 4. Thessaly test

a pediatric test for congenital hip dysplasia

Ortolani's test

Foraminal Compression Test (Spurling's test) at C-Spine

Pt. seated with head laterally flexed. PT places both hands on top of the pt's. head and exerts a downward force. + for cervical nerve root compression if pain radiates into arm toward flexed side

Which special test is not designed to identify a contracture or muscle tightness? a. ely's test b. fromment's sign c. piriformis test d. tripod sign

B Froment's sign is designed to identify the presence of neurological dysfunction, specifically ulnar nerve compromise or paralysis.

When administering Ludington's test, the patient is asked to: a. extend the elbow b. flex the shoulder c. contract the biceps brachii d. contract the triceps brachii

C Ludington's test requires the patient to clasp both hands behind the head with the fingers interlocked. The patient is then asked to alternately contract and relax the biceps muscles. A positive test is indicated by absence of movement in the biceps tendon and may be indicative of a rupture of the long head of the biceps.

special test for TOS that requires the therapist to monitor radial pulse

Costoclavicular syndrome test

Special test for femoral anteversion

Craig's test pt. lays prone with knee flexed to 90, while therapist medially and laterally rotates the hip to determine femoral anteversion (adult normal = 8-15 degrees)

Match the special test with the associated medial condition: Phalen's test

Median nerve compromise

Special test for lunate dislocation

Murphy Sign Pt. is asked to make a fist + if 3rd metacarpal is in line with 2nd and 4th metacarpals

Special test for ITB friction syndrome

Nobel Compression Test Pt. in supine with hip slightly flexed and knee in 90 degrees of flexion. PT places thumb of one hand over lateral epicondyle and the other hand around pts. ankle. PT maintains pressure over lateral epicondyle while pt. is asked to slowly extend the knee. + = pain over lateral femoral epicondyle at ~30 degrees knee flexion

Cervical Flexion Rotation Test

Pt. in supine. PT fully flexes pt's. c-spine. PT then rotates the c-spine in each direction while maintaining flexion. + for atlantoaxial dysfunction = limited rotation + for cervicogenic headache = reproduction of symptoms

Match the special test with the associated medial condition: Adson Maneuver

TOS

Match the special test with the associated medial condition: Allen test

TOS

T or F: 2 cm deviation in leg length as determined by a true leg length discrepancy test is significant

TRUE

a special test used to identify joint effusion

patellar tap test

2 special tests for swelling at the knee joint

1. Brush test 2. Patellar tap test

What special test designed to detect ACL injury requires the pt's. test knee to be flexed 20-30 degrees - Lachman test - Anterior drawer - lateral pivot shift - valgus stress test

Lachman test

special test requiring patient to place their hand behind their head

Ludington's test

Special test for iliopsoas, sacroiliac, or hip joint abnormalities

Patrick's test (FABER) Pt. in supine with test leg flexed, abducted, and lateral rotated at the hip onto the opposite leg. PT slowly lowers the leg through abduction toward the table

What test is being performed in the image? a. sacral springing test b. distraction test c. thigh thrust test d. compression test

B The sacroiliac distraction test is similar in concept to the compression test, but utilizes an opposite direction of force. This test stresses the anterior sacroiliac ligaments.

the drop arm test is performed with the pt. position in ___ degrees of shoulder ____

90 Abduction

special test designed to detect meniscal lesion

Apley's compression

Match the special test with the associated medial condition: patellar apprehension test

patellar subluxation or dislocation

static observation test to identify ligamentous deficiency

posterior sag sign

Which orthopedic special test would be performed with the patient in sidelying? a. Lachman test b. McMurray test c. Yeoman's test d. Ober's test

D Ober's test is performed with the patient in sidelying. The therapist abducts and extends the patient's top leg and then slowly lowers the leg to assess for tensor fasciae latae tightness. A positive finding would be the inability of the leg to reach the level of the table.

2 special tests for pediatrics

1. Barlow's test (hip dislocation) 2. Ortolani's Test (hip dislocation)

3 special tests for biceps tendon pathology

1. Ludington's test 2. Speed's test 3. Yergason's test

8 special tests for ligamentous instability at the knee

1. anterior drawer (ACL) 2. Lachman test (ACL) 3. lateral pivot shift (ACL) 4. posterior drawer test (PCL) 5. posterior sag sign (PCL) 6. Slocum sign (anteromedial/anterolateral instability) 7. valgus stress test (MCL, PCL, posteromedial capsule) 8. varus stress test (LCL, PCL, posterolateral capsule)

1 special test for medial epicondylitis

1. medial epicondylitis test

Match the special test with the associated medial condition: Finkelstein's test

De Quervain's disease

Special test for patellofemoral syndrome

Clarke's Sign Pt. in supine with knees extended. PT applies distal pressure to the superior pole of the patella and asks pt. to perform quad set + = failure to complete the contraction without pain

When performing the Hoover test, what patient action is required after the therapist grasps each calcaneus? a. perform a SLR b. perform a bridge c. actively abduct the hip d. DF the ankle

A The Hoover test is performed by the therapist grasping each calcaneus and then asking the patient to perform a straight leg raise. A positive test would result if the therapist was unable to detect pressure from the patient's contralateral heel into their hand as the opposing leg performs the straight leg raise. The test is designed to identify if the patient is malingering.

True leg length measurements are taken from what two anatomical landmarks? a. ASIS and medial malleoli b. ASIS and lateral malleoli c. iliac crest, medial malleoli d. iliac crest, lateral malleoli

A True leg length measurements are obtained by using a tape measure from the distal point of the anterior superior iliac spines to the distal point of the medial malleoli. The patient should be positioned in supine with the hips and knees extended with the legs 15 to 20 centimeters apart.

Roo's test is completed in sitting or standing with the pt's. shoulders positioned in 90 degrees of ____ and ____ rotation, and 90 degrees of elbow flexion

Abduction Lateral

A positive foraminal compression (Spurling) test is most indicative of: a. atlantoaxial instability b. cervical radiculitis c. vertebral artery compromise d. TOS

B Spurling test is considered positive if pain radiates into the arm toward which the cervical spine is laterally flexed during compression. Radiating pain is caused by pressure on the nerve root (cervical radiculitis).

5 special tests for RTC pathology

1. drop arm test (RTC tear) 2. infraspinatus test (infraspinatus strain/tear) 3. lateral rotation lag sign (infra/supraspinatus pathology) 4. lift off sign for medial rotation (subscapularis lesion) 5. Supraspinatus test (supraspinatus tendon tear or impingement)

Match the special test with the associated medial condition: Clarke's sign

Patellofemoral dysfunction

What special test would precede the measurement depicted in the image? a. Ely's test b. Craig's test c. Apley's compression d. McMurray test

B Craig's test is performed with the patient in prone and the test knee flexed to 90 degrees. The test is designed to determine the relative amount of femoral anteversion which can be quantified with a goniometer.

Which of the following would indicate a positive medial epicondylitis test? a. pain b. numbness c. radiculopathy d. demised radial pulse

A A positive medial epicondylitis test would be indicated by pain in the medial epicondyle region. The therapist palpates the medial epicondyle and supinates the patient's forearm, extends the wrist, and extends the elbow. A positive test may be indicative of medial epicondylitis.

A positive Finkelstein's test may be indicative of? a. ulnar nerve compromise b. ulnar collateral ligament instability c. carpal tunnel syndrome d. de Quervain's disease

D A positive Finkelstein's test may be indicative of tenosynovitis of the thumb (de Quervain's disease). The patient is asked to make a fist with the thumb tucked inside the fingers. The therapist stabilizes the patient's forearm and ulnarly deviates the wrist. A positive test is indicated by pain over the abductor pollicis longus and extensor pollicis brevis tendons at the wrist.

What special test is being performed if the therapist flexes the patient's shoulder to 90 degrees, flexes the elbow to 90 degrees, and medially rotates the arm? a. yergason's test b. supraspinatus test c. neer impingement d. hawkins-kennedy

D The Hawkins-Kennedy impingement test is performed by flexing the patient's shoulder to 90 degrees, flexing the elbow to 90 degrees, and medially rotating the arm. This movement pushes the supraspinatus tendon against the coracoacromial ligament and the coracoid process. Pain indicates a positive test for supraspinatus tendinitis or impingement.

What ligament is being tested in this image as the therapist provides a force towards the floor with the right hand? a. posterior talofibular ligament b. deltoid ligament c. calcaneofibular ligament d. anterior talofibular ligament

D The anterior drawer test can be performed both in supine and prone. Excessive anterior movement and sucking in of the skin on both sides of the Achilles tendon indicate a positive sign.

The Trendelenburg test is performed with the pt. position in ____ stand for ~10 seconds

SLS

Match the special test with the associated medial condition: sitting flexion test

Sacral articular restriction

What is a positive sign for the test depicted in the image? a. pain in the ulnar distribution b. lack of return of color to the hand c. pain in the radial distribution d. numbness and tingling in the fingers

B A positive Allen test is characterized by delayed or absent flushing of the radial or ulnar half of the hand and may be indicative of an occlusion in the radial or ulnar artery.

The Barlow test is used to test the stability of which joint? a. shoulder b. hip c. knee d. ankle

B The Barlow test can be used to detect congenital hip dysplasia. This condition, also known as developmental dysplasia, is characterized by malalignment of the femoral head within the acetabulum. A positive Barlow test is indicated by a click or a clunk and may be indicative of a hip dislocation being reduced.

Which artery does the examiner palpate while performing the costoclavicular syndrome test? a. ulnar b. radial c. carotid d. temporal

B The examiner palpates the radial artery when performing the costoclavicular syndrome test. The examiner then assists the patient to assume a military posture. A positive test is indicated by an absent or diminished radial pulse and may be indicative of thoracic outlet syndrome caused by compression of the subclavian artery between the first rib and the clavicle.

When performing Speed's test, what is the role of the examiner? a. passively abduct the shoulder b. resist active shoulder flexion c. passively medially rotate the shoulder d. resist active elbow flexion

B When performing Speed's test, the therapist should resist active shoulder flexion. The patient is positioned in sitting or standing with the elbow extended and the forearm supinated. The therapist places one hand over the bicipital groove and the other hand on the volar surface of the forearm. A positive test is indicated by pain or tenderness in the bicipital groove region and may be indicative of bicipital tendonitis.

Which of the following does not test for an anterior cruciate ligament injury? a. lateral pivot shift test b. lachman test c. posterior sag sign d. anterior drawer test

C A positive posterior sag test is used to identify a posterior cruciate ligament injury. The patient is supine with the hips and knees flexed to 90 degrees and legs supported at the calves by the clinician. The clinician attempts to identify changes in the contour of the tibial tuberosity between the involved and uninvolved sides.

Which of the following special tests would only be administered to infants? a. finkelstein test b. froment's sign c. ortolani's test d. murphy sign

C During Ortolani's test the patient lies supine with the hips flexed to 90 degrees. The therapist abducts the patient's hips and gentle pressure is applied to the greater trochanters until resistance is felt at approximately 30 degrees. A positive test is indicated by a click or a clunk and may be indicative of a dislocation being reduced.

When performing Yergason's test, how is the patient asked to actively move against resistance? a. supinate the forearm and medially rotate the shoulder b. pronate the forearm and medially rotate the shoulder c. supinate the forearm and laterally rotate the shoulder d. pronate the forearm and laterally rotate the shoulder

C When performing Yergason's test, the patient is asked to actively supinate the forearm and laterally rotate the shoulder against resistance. The therapist places one hand on the patient's forearm and the other hand over the bicipital groove. A positive test is indicated by pain or tenderness in the bicipital groove and may be indicative of bicipital tendonitis.

What would a positive Thompson test reveal when the calf is squeezed? a. absence of PF b. slightly diminished PF c. absence of DF d. slightly diminished DF

A The Thompson test is designed to assess the integrity of the Achilles tendon by squeezing the muscle belly of the gastrocnemius and soleus muscles. The patient is positioned in prone with the feet extended over the edge of a table. A positive test is indicated by the absence of plantar flexion and may be indicative of a ruptured Achilles tendon.

Which orthopedic special test would be performed with the patient positioned in sitting? a. ober's test b. tripod sign c. ely's test d. thomas test

B The Tripod sign special test begins with the patient positioned in sitting with the knees flexed to 90 degrees over the edge of the table. The therapist passively extends one knee. A positive test is indicated by tightness in the hamstrings or extension of the trunk in order to limit the effect of the tight hamstrings.

Match the special test with the associated medial condition: Brush test

Effusion in the knee

Which special test is depicted in this image?

Ely's test

T or F: normal ER of the tibia as determined by he tibia torsion test is 15-20 degrees in an adult

FALSE 12-18 degrees

Vertebral Artery Test

Pt om supine. PT places the pt's head into extension, lateral flexion, and rotation to the ipsilateral side. + for compression of vertebral artery if pt. experiences dizziness, nystagmus, slurred speech, or LOC

Match the special test with the associated medial condition: Ober's test

TFL contracture

Special test for Achilles tendon rupture

Thompson Test Pt. in prone with feet extended over the edge of table. PT asks pt. to relax and proceeds to squeeze calf. + = excessive adduction

An indication of hamstring tightness

Tripod sign

1 special test for ligamentous instability at the wrist

Ulnar collateral ligament instability test

Match the special test with the associated medial condition: Froment's Sign

Ulnar nerve compromise or paralysis

special test designed to identify nerve compression

tinel's sign

special test designed to detect bicipital tendonitis

Yergason's test

which finding would be most indicative of a positive test

apprehension or facial grimace prior to end point

6 special tests for contractures/tightness at the hip

1. Ely's test (rectus femoris contracture) 2. Ober's test (ITB or TFL contracture) 3. Piriformis test (piriformis tightness or compression of sciatic nerve) 4. Thomas test (hip flexion contracture, rectus formis contracture, ITB contracture) 5. Tripod sign (hamstring tightness) 5. 90-90 SLR test (hamstring tightness)

3 special tests for impingement

1. Hawkins-Kennedy impingement test (involves supraspinatus tendon) 2. Neer Impingement (involves supraspinatus tendon) 3. Supine Impingement test

Match the special test with the associated medial condition: speed's test

bicipital tendonitis

Which special test is depicted in this image?

hawkins-kennedy impingement test

Match the special test with the associated medial condition: Thomas test

hip flexion contracture

Match the special test with the associated medial condition: neer impingement test

impingement involving the supraspinatus tendon

Match the special test with the associated medial condition: Patellar tap test

knee joint effusion

which finding would be most indicative of a positive test

pain

Match the special test with the associated medial condition: Thompson test

ruptured Achilles tendon

a positive test would be most indicated by:

unilateral pain in the posterior pelvis

Match the special test with the associated medial condition: Lachman test

ACL sprain

4 special tests for neurological dysfunction at the wrist

1. Carpal Compression Test (median nerve) 2. Froment's Sign (Ulnar nerve - adductor pollicis paralysis) 3. Phalen's Test (median nerve - carpal tunnel) 4. Tinel's Sign (Median nerve)

Special test for patella subluxation/dislocation

Patella Apprehension Test Pt. is supine with knees extended. PT places both thumbs on the medial border of the patella and applies a laterally directed force. + = look of apprehension or an attempt to contract the quads, in an effort to avoid sublux/dislocation

Match the special test with the associated medial condition: Mill's test

Lateral epicondylitis

Special test for true leg length discrepancy

Leg Length Discrepancy Test Pt. in supine with hips and knees extended, the legs 15-20cm apart, and the pelvis in balance with the legs. Using a tape measure, the PT measures from the distal point of the ASIS to the distal point of the medial malleoli. + = bilateral variation of >1cm

When performing the Bunnel-Littler test, what is done to rule out capsular restriction? a. flex the MCP joint b. extend the MCP joint c. flex the wrist d. extend the wrist

A When performing the Bunnel-Littler test, the metacarpophalangeal (MCP) joint is flexed followed by the proximal interphalangeal (PIP) joint to rule out a capsular restriction of the involved digit. If the range of motion is unrestricted at both joints, the capsule is likely unaffected. The test begins with the MCP in slight extension. If the PIP joint does not flex with the MCP joint extended, there may be a tight intrinsic muscle or capsular tightness.

Which special test is depicted in this image?

Anterior apprehension test

Match the special test with the associated medial condition: Murphy's Sign

Dislocated lunate

Sitting Flexion Test

Purpose: Sacroiliac articular restriction Method: Pt. is sitting with feet on floor. PT palpates PSIS and monitors its movement as pt. bends forward and touches the floor. Positive Test: One PSIS moves farther in the cranial direction than the other PSIS.

Straight Leg Raise

Purpose: To determine the cause of low back pain Procedure: Pt. is supine. PT flexes hip while maintaining knee extension and slight IR of the hip. Flex hip until pt. experiences pain/tightness in LB/posterior leg (note degree of elevation and lower leg until pain is relieved). -Flex the hip until the client feels pain ( usually around 70-80 degrees of flexion) -Slowly lower the leg until no pain is felt by the client. -Dorsiflex the client's affected foot ( this stretches their sciatic nerve) Positive Signs: Hamstring Tightness - pain in the back of their thigh and knee during hip flexion Lumbar or SI Joint Dysfunction - pain in the low back after 70 degrees of hip flexion only ( no foot dorsiflexion) Sciatic Nerve Involvement - pain down the leg during passive dorsiflexion Space Occupying Lesion or Disc Herniation - pain down their opposite leg ( the one that is not raised)

Match the special test with the associated medial condition: Cozen's test

lateral epicondylitis

Match the special test with the associated medial condition: bounce home test

meniscal lesion

3 special tests for ligamentous instability at the ankle

1. Anterior drawer test (ATFL) 2. Lateral rotation stress test (Kleiger test) (high ankle sprain if pt. experiences pain over both A/PTFL and interosseous membrane OR deltoid ligament tear if pt. experiences pain medially and PT feels talus shift away from medial malleolus) 3. Talar Tilt (Calcaneofibular ligament)

2 special tests for contractures/tightness at the wrist

1. Bunnel-Littler test 2. Tight retinacular ligament test

3 special tests for lateral epicondylitis

1. Cozens 2. Mills 3. Lateral epicondylitis test (Maudley's test)

Match the special test with the associated medial condition: Slocum test

Ligamentous instability at the knee

T or F: normal femoral anteversion is an adult is 20-25 degrees

FALSE 8-15 degrees

the special test depicted in the image is the:

sacroiliac compression test

Special test for DeQuervvain's Disease (tenosynovitis)

Finkelstein test Pt. is asked to make fist with thumb tucked inside fingers. Therapist UD wrist. + = pain over abductor pollicis longus and extensor pollicis brevis

which finding would be most indicative of a positive test?

spontaneous ipsilateral hip flexion

Special test for degenerative joint disease at the CMC joint

Grind test Therapist grasps thumb and applies compression and rotation through metacarpal + = pain

Special test that could be indicative of abnormal/irritated plica of the knee

Hughston's Plica Test Pt. in supine. PT flexes knee and medially rotates tibia with one hand while the other hand attempts to move the patella medially and palpate the medial femoral condyle. + = popping sound over medial plica while knee is passively flexed and extended

Match the special test with the associated medial condition: Noble compression

ITB friction syndrome

Slump Test

Purpose: Neurological Dysfunction or sensitivity Method: Pt. seated at EOT and asked to "slump" (cervical/thoracic/lumbar flexion). PT places pt's foot into passive DF and asked pt. to extend knee (can also be done passively). If pt. can not fully extend the knee d/t pain, PT then asks pt. to extend their neck and try to extend the knee again. Positive Test: Pt. Symptoms decrease with release of neck flexion.

Standing Flexion Test

Purpose: Sacroiliac articular restriction Method: Pt. is standing with feet 12" apart. PT palpates PSIS and monitors its movement as pt. bends forward and touches the floor with extended knees. Positive Test: One PSIS moves farther in the cranial direction than the other PSIS.

a positive test for the drop arm test is indicated by the pt's. failure to slowly lower their arm to their side or the presence of severe pain. A positive test may indicate the presents of a ___

RTC tear

Match the special test with the associated medial condition: Ely's test

Rectus contracture

Match the special test with the associated medial condition: Wright test

TSO: compression in the costoclavicular space

Special test for tibial torsion

Tibial torsion test Pt. in sitting with knees over EOT. PT places thumb and index finger over medial and lateral malleoli and measures the acute angle formed by the axes of the knee and ankle (adult normal = 12-18 degrees)

5 special tests for TOS

1. Adson maneuver 2. Allen test 3. Costoclavicular syndrome test 4. Roos test 5. Wright test (hyperabduction test)

The posterior drawer test is performed with the knee flexed to ___ degrees and the hip flexed to ___ degrees

90 45

1 special test for vascular insufficiency at the wrist

Allen test (radial or ulnar artery)

Weakness and pain during a supraspinatus test may indicate impingement involving the supraspinatus tendon or ____ nerve involvement

suprascapular

What special test assesses the integrity of this structure? a. anterior drawer test b. mcmurray's test c. posterior drawer test d. Hughston's plica test

B The structure identified by the arrow is the medial meniscus. McMurray's test involves compression and rotation in an attempt to identify a meniscal tear. A positive test is indicated by a click or pronounced crepitation felt over the joint line and may be indicative of a posterior meniscal lesion.